10-18-2017, 10:29 AM
(10-18-2017, 07:48 AM)doctorK Wrote:(10-18-2017, 07:36 AM)Guest Wrote: So what are you saying?
That if you don't train at one of these places, you won't be a good surgeon?
I don't think that is the intended meaning of the post and the comments. If you have rotated at your home institution and completed at least one Sub-I, you will see that there are obvious disparities in surgical skill among residents of the same PGY between institutions, also within the same institution.
Some of this is due to the actual set-up of the residency training and when residents go through various rotations, and some of it has to do with the climate of the residency program (rigid hierarchy vs. early autonomy vs. mixed bag).
But, the reality is that every program must graduate residents with minimal competencies. One thing that I noticed was that even if there was disparity between skills level at PGY2-6, there was a nearly complete leveling-out of skill sets and confidence in the PGY7s across institutions.
At a given institution, you may see more spine or you may see more tumor etc - so you'll be more comfortable in some arenas obviously. But you'll end up as a good surgeon no matter where you train.
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I wholeheartedly disagree. I have been a medical student, rotated at some of these programs, done second looks, and am now a resident.
There is a huge variation of surgical competence from program to program. Not all PGY2s are equal. Not all PGY7s are equal.
To say that everyone levels out at the end is ridiculous.
The culture of a program does not suddenly change as you become a senior resident. Attendings who are overly-controlling and hands-on do not just hand over the instruments once you are a chief.
If you are never given a chance or the autonomy as a junior resident to develop a solid set of base skills, then you will be given minimal freedom in the "complex" cases that seniors are assigned to.
Will you be a competent surgeon who is legally allowed to practice neurosurgery if you hit your "minimal competencies"? Yes
Will you be able to refine your technical skills in a legally protected (can't be sued as a resident) and supportive environment (can call staff in to help you) while doing complex cases? Only at a few places
You used to be able to train anywhere and be a good surgeon. But nowadays the autonomy of past generations has been suppressed by a medical-legal environment and deluge of non-operative work dumped on residents. There are few places that seem interested in actually training the future generation of surgeons to be technically adept, instead of abusing residents as work monkeys and paper-writers.
http://www.kevinmd.com/blog/2016/12/resi...rgeon.html
